1353. Institutional and Systematic Review to Identify Factors Associated with Favorable and Unfavorable Outcomes After Sciatic Nerve Decompression for Piriformis Syndrome

Award: Second Place Peripheral Nerve Eposter Award

Authors: Christopher D. Wilson, MD; Piiamaria Virtanen, BS; Elliott Yee, BS; Alan Yaacoub, BS; George Eckert; Nicholas Barbaro, MD (Indianapolis, IN)


Piriformis syndrome accounts for 0.3-6% of sciatica. Orthopedic and neurosurgical literature endorse high success rates after sciatic nerve decompression. Authors endorse factors associated with favorable outcomes after decompression in small studies. No definitive associations have been made. We combine the literature by systematic review to identify factors associated with differential postoperative results and highlight the success of sciatic nerve decompression in the neurosurgical literature.


We searched our institutional database of sciatic nerve decompression at the level of the buttock between December 2012 and July 2018. A literature search collected data from articles discussing sciatic nerve decompression. Data regarding factors were combined by systematic review to identify associations with favorable outcomes. Factors evaluated included age, gender, procedure history, preoperative signs and symptoms, symptom duration, etiology, imaging abnormalities, electrodiagnostic abnormalities, surgical approach, and operative findings.


Twenty-six institutional cases had sufficient data for review with median 12.1-month follow up with favorable outcomes in 85%. An additional 440 operations were identified among 48 published studies with a favorable outcome in 92%. Only five articles were published in neurosurgical journals. No factors were significantly associated with more favorable or unfavorable outcomes including preoperative symptoms, age, comorbidities, imaging abnormalities, electrodiagnostic results, etiology, preoperative symptom duration, degree of preoperative disability, and open or endoscopic approach. Nonsignificant trends towards more favorable outcomes occurred in patients noting significant social life impairment, operated beyond 12 months after symptom onset, without conduction velocity slowing, and without sciatic nerve FLAIR abnormality or enhancement. Only five articles were published in neurosurgical journals.


We present our experience in combination with published data regarding sciatic nerve decompression. After careful diagnostic evaluation, postoperative outcomes are generally favorable regardless of comorbidities, disability, or symptom duration. Outcomes are published predominantly in non-neurosurgical literature. We highlight the excellent surgical outcomes of this neurological disease.